Beginning

According to The Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death for people in the United States today. It is estimated that 610,000 Americans (one in four) die of heart disease every year. Coronary heart disease (CAD), the most common type of heart disease, leads to 735,000 heart attacks and kills more than 370,000 men and women annually (CDC). Atherosclerosis is considered to be a preventable disease in the United States, since it’s largely attributed to less-than-ideal lifestyle habits like poor diet, lack of regular exercise, drug or alcohol abuse, and high stress. Studies show that ancient peoples also suffered from atherosclerosis and heart disease, and there have been treatments for this illness dating back thousands of years, as proved by the arteries of Egyptian mummies who were 3,500 years old. They too had clear evidence of heart disease and approximately half of the scanned mummies had signs of atherosclerosis, similar to rates found today (Hanke et al, 2001; Columbia University, 2016).

Pathophysiology

Atherosclerosis is a slow and progressive disease and is the major underlying cause of cardiovascular diseases. While we aren’t definitively sure which risk factors are to blame for the Egyptian mummies’ atherosclerosis, we do know that current primary risk factors include hypercholesterolemia, hypertension and cigarette smoking, likely the same factors that led to the mummies’ blocked arteries. These risk factors, coupled with the oxidation and inflammation in the artery wall, often because of collagen-induced platelet aggregation, give rise to characteristic fatty-fibrous lesions over time. Rupture of these lesions, whether due to trauma or inflammation, leads to heart attack, stroke or increased plaque growth.

As low density lipoprotein (LDL) and other macromolecules are transported through endothelial cells into the vascular intima, LDL is retained in the sub-endothelium by a charged interaction with matrix proteoglycans. This embedded LDL is attacked and oxidized by reactive oxygen species (ROS). High oxidative stress, due to hypertension from abnormal renal function and the increased production of angiotensin II and reduced glutathione peroxidase due to cigarette smoking, can cause adhesion of platelets following any endothelial injury, and is the event usually associated with uncontrolled platelet activation resulting in intravascular thrombosis (Surin et al, 2008). These factors demonstrate that heart disease isn’t just one factor, but a compiled effect of the major risk factors for atherosclerosis. Over time, fatty-fibrous lesions characteristic of atherosclerosis develop. While stable plaque has a preponderance of smooth muscle cells embedded in a dense matrix of collagen, unstable plaque usually has a large core of inflammatory cells and debris from dead cells. The cap of these plaques is often fragile and lacking endothelial cells. These unstable lesions are subject to excessive inflammation and particularly prone to physical disruption.

Although plaque rupture is the cause of clinical events, in many cases it is silent as the thrombus is absorbed into the existing plaque. Plaque growth is then stimulated by the release from platelets, which again stimulates smooth muscle cell recruitment, proliferation, and production of dense collagen matrix. New micro-vessels in the plaque tend to be very fragile and prone to rupture (intra-plaque hemorrhage).

Fortunately, diagnostic markers exist and disease progression is indicated by C-reactive protein (CRP). Other early indicators of heart attack are inflammatory marker CD40 and the cardiac myofilament protein troponin. When we see these markers, we can take action to support our patients through diet and lifestyle changes coupled with medication.

Ayurvedic medicine sees the human as being fully connected and a part of nature. We are believed to possess an inherent tendency to love, heal and harmonize. Tradition has long held that Anahat Chakra (the heart chakra) lies at the center of the seven chakras and it governs the physical, mental, experiential and emotional activities. Specifically, the heart chakra contains the emotional functions of love, confidence, trust, and connections to others and environment. The highest functions of Anahat Chakra are unconditional love and love for the self. It is the root of prana, the life-force. When out of balance, we experience vulnerability, loss of confidence, anxiety, emotional distress and dependency.

Treatments of yesterday are not dissimilar to treatments today. Historical recommendations were to reduce salt, improve diet and increase exercise, just like today. While they didn’t have statins, they did have herbal formulas, which were so effective that we utilize them and their extracted constituents in the modern age. Common herbs used for ancient problems of hypertension include Rauwolfia serpentine, rose, Boerhaavia, Tribulus terrestris and shells. We use many of these same herbs to this day, but with the caveat of having scientific studies to now back up their use.

One of the most used herbs for heart and cardiovascular problems is Rauwolfia serpentina, which has been used traditionally to maintain blood pressure and support heart function. Rauwolfia s. has been documented for use since 600 B.C.E. in the Sushruta Samhita for controlling hypertensive symptoms. Rauwolfia s. contains reserpine, an alkaloid, which activates the parasympathetic nervous system. In 1949, Rustom Jal Vakil published his study in the BMJ about 50 patients he treated for high blood pressure with Rauwolfia s. (Vakil, 1949). It became so popular amongst Indian doctors that it is reported Mahatma Gandhi used Rauwolfia s. tea at the end of the day.

Rauwolfia s. doesn’t contain only reserpine, but notably also yohimbine, another alkaloid, which balances the effects of reserpine. When used in whole herb form, Rauwolfia s. is known to drop systolic numbers by 20-30 mm Hg and diastolic 10-15 mm Hg. However, high doses of extracted reserpine are known to cause side effects like nausea, dyspnea, and fainting as well as withdrawal symptoms (Lobay, 2015). When used in formula, reserpine is found in very small doses compared to the extracts, which rely on larger amounts to get the same effect.

Rose has long since been connected to the heart, both poetically and physiologically. In studies, rose has been shown to reduce systolic and diastolic blood pressure, “reduce total plasma, cholesterol, and total cholesterol/HDL cholesterol ratio,” improve glucose tolerance, and reduce “fat mass, body weight, and insulin levels.” However the researchers noticed one finding that stood out—“decreased atherosclerotic plaque formation at the level of the aortic tree” (Cavalera et al, 2016).

Boerhaavia diffusa aids the body by attenuating angiotensin II induced hypertension and hypertrophy in cardiac cells by modulating oxidative stress (Prathapan et al, 2013). Boerhaavia d. reduces the constriction of the vasculature and is a known diuretic. Convolvulus pleuricaulis is typically used as a nootropic due to its relaxing and calming effects on the body. Studies of the herb have shown varying degree of its hypotensive and tranquilizing effects, including patients with anxiety neurosis. Convolvulus p. induces feelings of calm, supports restful sleep, and relieves anxiety, stress, and mental fatigue through modulation of neurochemistry of the brain (Agarwa et al, 2015).

Tribulus terrestris, well known for its beneficial effects on men’s health and testosterone levels, has shown to be protective against ischemia and reperfusion induced cardiac damage (Reshmi et al, 2015). Tribulus t. increases the free=radical scavenging activities of super oxide dismutase (SOD) and protein kinase C epsilon (PKC-Ε), an enzyme which protects cardiac cell damage due to hypoxia (Zhang et al, 2010). One study found that when taken post myocardial infarct, Tribulus t. improved cardiac functions and ejection fraction while preventing remodeling and even improved lipid profiles (Guo et al, 2007). It has also been shown to relieve angina with 82.3 percent efficacy through coronary artery dilation and improved cardiac circulation, and without side effects like liver or kidney damage (Wang et al, 1990). Maybe even more promising, is that when taken prophylactically, Tribulus t. inhibits platelet aggregation when platelets are exposed to collagen by inhibiting peroxidation of arachidonic acid (Olas et al, 2015). Tribulus also decreases ACE levels (Sharifi et al, 2003), which results in lower blood pressure and has a significant diuretic effect (Al-Ali et al, 2003).

Terminalia arjuna, an ancient ayurvedic herb is used primarily as a support for healthy heart functions, has been shown to have flavone arjnonlone, tannins, arjunic acid and glycosides, the effects of which may be correlated to the observed benefits of arjuna, like regulating heart rate and strength of heart muscle contraction (Dwivedi, 2007).

Summary

Whole herbs and herbal formulas, more than single, extracted “key” constituents, are one of our most powerful allies in the fight against cardiovascular diseases. Many of the herbs described above not only help with cardiac function due to one constituent, but contain many other constituents which aid in supporting the desired effect from the first component. When we extract these key components of an herb, we lose these broad-spectrum functions of the plant, something that traditional herbalists consider when building a formula. Our formulas are planned out to balance the effects of the herbs against one another while providing effective treatment for not just lowering inflammation, but also activating the parasympathetic nervous system, decreasing ACE levels, and regulating heart functions. The key to cardiovascular health is in the regular, smooth functioning of the entire system so that platelet aggregation and thrombus formation is minimized. Whole herbs, whether used alone or in formula, are our best bet for safe and effective treatment to restore the body.

Bio-Box:

Growing up near the Himalayas, Dr. Shailinder Sodhi developed an early interest in ayurvedic plants and herbs, and received his BAMS (bachelor in ayurvedic medicine and surgery) degree from Dayanand Ayurvedic College in Jalandhar, India in 1985. In 1993, he received a naturopathic medicine degree from Bastyr University, as well as a degree in diagnostic ultrasound from Bellevue College. Dr. Sodhi practices naturopathic medicine along with his wife, Dr. Anju Sodhi, and his brother, Dr. Virender Sodhi, at the Ayurvedic and Naturopathic Medical Clinic in Bellevue, WA, which he established in 1989. In addition, Dr. Sodhi serves as president of Ayush Herbs Inc., a manufacturer of high-quality ayurvedic herbal formulas, is an adjunct faculty member at Bastyr and has been published in several natural health magazines.

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